How to Modify Abdominal Exercises for Pelvic Floor Protection

Abdominal exercises have the potential to impact upon the pelvic floor, particularly with intense core abdominal exercises and poorly functioning pelvic floor muscles. It can be very confusing to know how to modify some commonly performed intense core abdominal exercises especially when you are participating in a main stream fitness class.

This short Physiotherapist video shows you how to modify some commonly performed abdominal exercises to reduce pelvic floor loading. Scroll down below for written guidelines for how to modify intense abdominal exercises.

Intense Abdominal Exercises & Pelvic Floor Load

Intense abdominal exercises involve strong contractions of the abdominal muscles. The upper abdominal muscles generate a large amount of pressure within the abdomen. The muscles surrounding the trunk manage the pressure generated by the abdominal muscles- the pelvic floor muscles withstand the pressure generated and applied to the pelvic floor.

If the pressure associated with abdominal exercises is too great for the pelvic floor muscles to withstand, then the pelvic floor is forced downwards, causing the pelvic floor muscles to stretch and weaken. Abdominal exercises that repeatedly force the pelvic floor downwards, or particularly intense core abdominal exercises that completely overload the pelvic floor should be modified in women at risk of pelvic floor injury.

Who is at Risk with Intense Abdominal Exercises?

There is no one single abdominal exercise prescription for everyone. The capacity of your pelvic floor to withstand intense core abdominal exercises is likely to be different to that of the woman next to you in your exercise class. The abdominal exercises that you should match the capacity of your pelvic floor muscles to withstand the associated pressure.

How to Modify Intense Abdominal Exercises

Abdominal exercises can be modified to reduce pelvic floor loading. This is a matter of reducing the intensity of the abdominal muscle contractions, and reducing the requirement for the pelvic floor muscles to contract for extended periods of time with repeated abdominal exercises or extended abdominal muscle holds.

How to Modify Abdominal Curl Exercises

Abdominal curls or sit up exercises involve head and shoulder forward raises. It is difficult to modify the intensity of this particular exercise which should ideally be avoided in women with pelvic floor dysfunction or very weak pelvic floor muscles.
The pelvic floor loading associated with abdominal curls can be decreased by:

Doing fewer repetitions

Breathing out as you sit up

Minimising resistance on abdominal curl machines.

How to Modify Double Leg Raises

Double leg raises or exercises involving both legs raised simultaneously are commonplace in gyms and women’s fitness classes including Pilates and Yoga.

The pelvic floor loading associated with double leg raises is readily modified by raising one leg and keeping head and shoulders down in contact with the mat throughout. Once again avoid breathe holding and try to breathe normally throughout.

How to Modify Plank or Hover

Full Plank or Hover involves weight bearing through the forearms and the feet. This is an intense abdominal core muscle exercise.

The pelvic floor loading associated with full Plank or Hover can be reduced with:

Kneeling rather than supporting body weight through feet

Breathing normally and avoiding breath holding

Reducing the duration of the abdominal exercise

Avoiding actively contracting the abdominal muscles or over bracing the abdominal muscles during the exercise.

Intense core abdominal muscles have the potential to overload the vulnerable pelvic floor. Many abdominal exercises can be modified to reduce pelvic floor loading for women at risk of pelvic floor injury. This is a matter of reducing the requirement for the pelvic floor muscles to work to counteract the pressure associated with intense core abdominal exercises.

Michelle Kenway is a Pelvic Floor Physiotherapist and author of Inside Out – the Essential Women’s Guide to Pelvic Support. The Inside Out exercise DVD and book show women how to exercise effectively with pelvic floor safe exercises.

Comments

Hi Marg
I was hoping you would see this! Thanks so much for your information request, it helped prompt me to get some more abdominal exercise info together. Good luck and take things slowly
Best wishes
Michelle

Hi Michelle
Thank you for the video. This prompts me to ask if the following is safe: I have been doing clinical Pilates for years & since my prolapse became apparent in a modified form. On the reformer bed I still do leg extensions with both legs raised but supported in slings with a moderate spring, I don’t come back past 90degrees but both legs push out at once, I don’t push high! Similar, I have knees raised,low & hands in slings & pull my arms over & down. What do you think please? Thank you Pamela

Better late than never…my apologies for the delayed reply to you Pamela. Thanks for this great question/comment.

Following communication with Physiotherapist Jenny Tweedie who teaches Pilates to women with pelvic floor dysfunction I can provide you with the following information about Reformer and pelvic floor safe exercises.

Regarding leg extensions on the reformed bed:
It is important to know you can activate pelvic floor muscles and low abdoinals correctly to get into tabletop position – this can be achieved using real time ultrasound which a number of Physios use to view what these muscles are doing during core abdominal and pelvic floor exercises.

For the ‘legs in straps’ exercises, the aim is to keep the pelvis neutral (usually the normal inward lower back curve and pelvis stable) while the legs move – the idea being to maintain neutral pelvis position using the correct abdominal and pelvic floor contraction throughout the exercises. In actual fact the higher or straighter the legs the better provided that the hamstrings are not too tight since the lower legs position is more difficult to maintain with correct core contraction than the higher leg position. Keeping the legs lower will require greater core strength and control, so better to have them higher for women who are unsure about their pelvic floor capacity. Head should stay down flat with legs in straps exercises.

Jenny says she really likes the legs in straps exercises for women who have satisfactory core activation. She uses them for postmenopausal women and says that this series can also be performed on the Cadillac by women after pregnancy for women with pelvic instability problems too.

Best of luck, hope this information helps you and thanks to Jenny too
Michelle

Hello Michelle,
Somehow I think my reply to your query,”what am I doing for back pain” got lost. .. By me, no doubt.To help you place me, ( from Friday) Iuse Mobiliswhen ,needed, Panadol osteo, have used glucosamine for years and trying boswellia with it, now. So it’s just pain relief, but am cross that I am stiffening a bit whereas I used to be quite flexible.(makes dressing etc harder. ) I did have foot drop after the 2 Nd disc, traction was a blessing!(30 years ago)So I’m getting used to the idea of probably the webbing op for rectocele but the p fl exercises have helped me put off the evil hour!Just cowardly, really. But I’d love any more stuggestions. Thank you

Hi Valerie
Yes it is usually safe for most women with prolapse to use an exercise bike – there are some tips for keeping cycling and prolapse with correct positioning and how to fit your bike in this article link.
Cheers
Michelle

Michelle
Thanks so much for your information. Regarding Kegels and uriniary incontinence, how long does it take before someone sees improvement. It’s been 5 weeks, and I don’t feel I’m improving much.
Lynnette

Hi Lynnette
It really varies ffrom one woman to the next. Some women find that Kegels help their continence improve within a few weeks whereas others find that it can take some months. We do know from studies that for with weak pelvic floor muscles, it can take 5-6 months to make full strength gains with pelvic floor or Kegel exercises. It may be useful to see a pelvic floor physio to assist you and check your technique is correct if you are not already doing so. Also remember the importance of strong contractions when you are capable of doing these and in upright positions.
Cheers
Michelle

I live in the US and found your website after doing searches for information on hysterectomies. I will be getting a total hysterectomy in a few weeks due to endometrial cancer, and I wanted to find some safe exercises to aid in my recover and found your site.

Which books would you recommend for me? I was looking at the Pelvic Floor Recovery book and Inside out. Do you think I could use both books? I really want to know what I can safely do to recover and regain pelvic strength.

Also, do you have any idea when you might have DVDs for US customers? I saw that you are working on this. I would love to be able to purchase some DVDs too.

Hi Pat
Thanks for your qns/comments. Yes the Inside Out DVD is available in two formats – one especially for ladies in the US and one for rest of world so that all ladies can play on their DVD players.

Pelvic Floor Recovery handbook is an excellent reference for ladies undergoing or following hysterectomy surgery. Inside Out book outlines pelvic floor safe exercises to choose (and those to avoid) long-term and includes a strength training exercise program. These are quite different books, the former for surgical recovery and the latter for pelvic floor strengthening and pelvic floor safe exercise.

Thanks for that information. I had ordered the Pelvic Floor Recovery handbook, and after receiving your additional information I went back and ordered the Inside Out book and the DVD. I know that I will make good use of them.

I just found your website and am very interested. I am 30, have not had children, and don’t have any pelvic floor dysfunction but I’m wondering how important it is to avoid loading the pelvic floor as a preventative measure. Do the usual abdominal exercises damage the pelvic floor muscles when done regularly over time?

Hi Elisabeth
Thank you for your question, it is a very good proactive one. I think this really comes down to your individual risks – as you say you haven’t had children so this isn’t a cuurent risk factor for injury. Risks factors for pelvic floor overload include individual factors such as chronic constipation and straining, chronic chest problems that cause coughing, inherited laxity in the tissues and chronic lower back or pelvic pain. The pelvic floor needs to be able to withstand the load placed upon it so it needs to be strong supportive and well functioning, especially with heavy lifting, high impact exercise or intense core exercises. Studies have shown that young female trampolinists suffer increased incidence of stress incontinence (bladder leakage with activity/exercise) so we know that pelvic floor problems can occur in women who repetaedly strain with impact. It is not yet known whether the same is true for intense abdominal core exercises and this will depend on individual pelvic floor strength. It may well be that regular abdominal exercises strengthen the pelvic floor in women with intact well functioning pelvic floor muscles as the muscles contract to counteract the downward pressure of the abdominal exercises.

There is also a risk of increased pelvic floor muscle tension or tightness in some women who engage in intense abdominal core exercises, particularly those with well functioning pelvic floor muscles – the key is to be able to relax the pelvic floor muscles having ceased the core abdominal exercises and avoiding constant overbracing of the lower abdominal muscles.

In summary moderation is the key with abdominal exercises, ensuring you can relax and contract your pelvic floor muscles, as well as matching the abdominal exercises you choose to your pelvic floor capacity and your known pelvic floor risk factors.

Hi Michelle, I haven’t ordered the dvd yet, but I am after finding your site. I have a prolapse that is consuming my life.It bulges out of vagina at times and if not my vagina feels so floppy and airey I HAVE BEEN WORKING ON POSTURE FROM THE WW SITE. AND HAVE BEEN DOING THE TTAP organs in place/half frog exercise 2 times a day for 2 weeks.I felt like my pelvic was getting stronger, but today it seemed worse.Is this a good exercise or should I not do them? I also try to do kegels. Please help as I don’t want urgery. I want to work hard and get my life back. I am 68

Hi Peg
If your prolapse feels worse, it may well be that you are doing something to increase the load on your pelvic floor. What is the ttap half frog exercise? I am hoping that the half frog exercise does not involve a wide leg deep forwards bending squat as it tends to suggest – this is an exercise position to avoid with a moderate prolapse. Let me know Peg.
Cheers
Michelle

Hi Michelle, thanks for answering me.. It is hard to explain, but if you search on the internet, type in ttap organs in place and it should be the first one. I was told by someone who had prolapse that this helped them.

Hi Peg
OK now I have seen the exercise you are referring to. Peg exercises that involve both legs raised above the body use the strong outer abdominal muscles. When these muscles contract they actually place a downward pressure on the pelvic floor. For women with prolapse problems and/or weak pelvic floor muscles this can force the pelvic floor downwards and worsen pelvic floor problems. I would strongly suggest against doing exercises laying on the back with both legs raised above the body to avoid worsening prolapse problems. Don’t hesitate to let me know if you need further clarification on this issue.
Kind regards
Michelle

I recently discovered your You tube videos and they have been godsend. I have a vaginal vault prolapse after a hysterectomy which was exacerbated by a period of heavy lifting of a wheelchair, mobility scooter and an elderly relative. I subsequently sent for your dvd ‘Inside Out’ and it has been such a help to discover that there are ways to adapt exercises so that my pelvic floor isn’t compromised. Thank you for your clear, enthusiastic and engaging presentation and excellent demonstrations.

Hi Michelle
I have just found your website. I have recently been diagnosed with a prolapse. I go to yoga classes twice a week and wondered if there are any postures I should avoid. Are there any exercises I could do that would help?
I would appreciate any advice you can give.
Thanks
Lizzie

Dear Michelle,
I am 65 and have had a bladder prolapse for 3 years. I have ordered your DVD and have been studying your online videos, especially those for modifying exercises in mainstream Pilates and Yoga classes. I also like walking and swimming and wonder if you can give advice on protecting the pelvic floor during these activities. I am so glad to have found your website; the more I read and study your techniques, the more confident I feel in managing my body. Many thanks,
Louisa

Walking and swimming are low impact pelvic floor friendly forms of exercise that are comfortable for many women with prolapse issues.

As for walking – keep surfaces flat, wear well cushioned shoes, alternate your walking surface (avoiding hard concrete fir the entire walk where possible) and keep the walking distance within a tolerable distance. Sometimes walking can be better tolerated in a couple of short walks rather than long disatnces.

Swimming or water exercise offers many pelvic floor friendly possibilities – water walking (forwards, sideways, backwards), cycling on a noodle, swimming laps all strokes other than butterfly, avoiding hard kicking with flippers if the pelvic floor is very weak or post op.

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Just wanted to say a quick thank you for your wonderful website and all the fantastic educational videos. I am three weeks post op from my surgery and your site has answered many important questions for me and helped me on my way to recovery. Big thank you!

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